Time to Go

I leave today to meet with a pastor in Tanzania who has asked for a medical team to visit. Everyone else leaves Rambia tomorrow after a debriefing meeting with the staff, then flying home Saturday morning. So it’s time to move along. To the readers of this blog and all our supporters and donors, thank you for your donations, your encouragement and your comments. To the two mothers who delivered their babies last night we pray for a speedy recovery and good health. To the staff and Board of RAMBIA, thank you for all your hard work and dedication, and many kindnesses to us. And to my fellow team members, the last word is yours:

Amy

Last night I proposed a toast over dinner to “the ups and downs of Uganda”.  For me, this represented not only the day’s journey of riding up and down the steep pot-holed dirt trails of the Rwenzori foothills on the back of a “boda-boda” to discuss health promotion with villagers in their homes, but also the emotional experience that is working here, living here, and just being here.

The past two weeks have been one of the most enriching experiences of my life.   To try to capture it in words is difficult.  There have been moments that have filled me with joy: sharing music with “Rebecca” from my ipod, driving back from Kibali as the sun set over the lush countryside, receiving jubilant cries from children and toothless smiles from the elders along the roadside, and meeting  the students of the community schools, so bright-eyed and eager to learn how to improve their health and the future health of Ugandans.

There have also been moments when I have felt disappointment, frustration, and sadness.  Seeing many patients with advanced disease that has gone untreated for years, and so much preventable illness causing suffering and taking lives.  Seeing the way of life of the poorest of the poor: no clean water, no soap, no shoes, rags for clothing, no medicines, no books and little hope.  The missing generation, lost to AIDs and civil war.  It is one thing to know of the existence of the vast divide between the rich and poor in today’s world, and a whole other thing altogether to come face to face with it, to look into the eyes of it, literally. 

Yet despite their suffering, the spirit of Uganda’s people is strong.  We have met and worked with some amazing people here.   Daniel and Rambia have accomplished much despite limited resources, training, and funding.

I will be returning home not only with much additional knowledge of tropical disease and of caring for patients in low-resource areas, but also with knowledge of the suffering endured by people of developing countries, knowledge of the strength of the human spirit, and, perhaps most importantly, knowledge of the power of giving.              

My heartfelt thanks goes out to all those who donated money, clothes, other items, and time to this project.  Please continue to do so as much work is still to be done as we move toward improving the health and quality of life of the people in and around Kyamakube. 

Nancy

Being part of the EMAS Uganda team was a dream come true for me. An adventure I always wanted to do. Saying that, nothing prepared me for what I witnessed, lived and felt.

I now know the true meaning of poverty. I must say that I was very shocked during my stay especially at the beginning. How could anybody live like this and be happy? Well, they can even though they they want better conditions for their families. I felt a lot of frustration because of their living conditions and didn’t know if our 2 weeks had any impact. After numerous conversations with the team members, I came to the conclusion that my goal was to help them get organized and give strategies to cope and improve. If I touched one life my goal has been met but I never expected to be touched so deeply by them. I go home happy knowing I gave to the residents of Fort Portal and surrounding villages my everything! It has been a privilege to work with every member of this team. Thank you to Peter, Emma, Neve, my parents, sisters and friends for all their love and wonderful support. God bless you all!

Lynda

I am so tired I can’t write! But I feel so blessed to have had a return opportunity to serve in Uganda and witness the visible changes since last year. I felt an undeserved joy in sharing with these special people the love and compassion God has shown me.

Despite our limited time, the extension this year to go beyond our work in the clinic into the schools and villages has provided a clearer vision of their circumstances and needs. Our hope is that through education, empowerment, treatment of their medical needs and sharing a small portion of the abundance we’ve been given we will make a lasting difference to these wonderful people.

My highlight? The contagious smiles on the faces of both young and old when I told them “ Yesu Nakugonza” : Jesus loves you, and “Yesu Ali Mu” : Jesus lives in your heart!

Meeting with the Community

On Friday we invited the Village Health Workers to the clinic. These volunteer workers are the first line of defence in the health care system, visiting homes, encouraging those who are sick to seek help and educating the community in good health practices. Last year it proved difficult to bring them in but this year, knowing the difficulties, it was planned ahead and we had 64 of them attending. They are terribly under-resourced, lacking the basic medications to treat even malaria and not having the funds to travel. Debbie talked to them about primary health care issues and then we arranged to visit some households with them. As part of our outreach we also met with the heads of some of the local councils to hear their concerns and ask for their input to some of our ideas for projects.

On Monday morning Lynda and I went with Daniel to visit two primary schools close to Rambia’s health clinic with more scheduled for the afternoon and other days this week. Last year we visited just one school but this year we wanted to expand this work because it gives us the opportunity to talk to the children about basic hygiene and to learn about their facilities– and of course the children are great fun to be with. They are always over the moon to see the “mzungus” and Lynda has them rolling on the grass as she practices her few words of the local Toro language. She keeps them spellbound as she demonstrates how to wash their hands and talks to them about using the latrines. This is absolutely the kind of work that Lynda is meant to do – and I never wash my hands in the same way again after listening to her.

While these times are great fun I found myself very sad afterwards and can’t quite explain why. It’s probably a combination of factors. For example, we decided not to talk to them about the importance of boiling water because we know that most families can’t afford the fuel – or the time – to do it. We distributed vitamin A vials but had to limit the distribution to the very youngest children – vitamin A deficiency is common here. There was no source of water, clean or otherwise at either school, so children drink from the nearby river. The pit latrines are full and in terrible shape. We know that we’ll continue to see typhoid, gastro-intestinal and other related problems at the clinic until this community and these schools have access to clean water, and proper latrines so that open defecation is a thing of the past. And perhaps the final thing that makes me sad is that we know how to fix these things and the cost, though insurmountable by local standards, is modest by ours.

A Tough Story to Tell

I am hopelessly behind on this blog and it's late, but I have to tell you about one patient. On Friday a woman came into the clinic in labour. As Nancy checked her out, she noticed blood on her feet. On questioning the woman, the staff said that she had just delivered. Nancy said no, I don’t think so, she is pregnant. The actual story is this. The woman had delivered a dead baby in her garden, then walked to the clinic where Nancy delivered the twin. Critical to the birth was a suction machine that Paul and Debbie had ordered and which had just arrived that morning. The baby was premature and had to be resuscitated which Debbie did. The mother haemorrhaged severely so again the oxytocin that Paul and Debbie had purchased was essential. The clinic is not equipped to look after a premature baby so after the delivery the woman walked to our van and our driver Francis drove her and the baby and Paul down the bumpy road to the public Buhinga Hospital in Fort Portal. They would have turned her away (their only incubator was out of order) but Paul insisted that they take her because the baby needed a feeding tube.

Third Day of Clinic

Wednesday

Nancy and Lynda have been spending time with the abandoned girl at the clinic – lets call her Rebecca. They have bought her bed sheets and sandals, and given her some clothes. All this time, there has been not a word out of her. Suddenly this morning she said “thank you”, giving Nancy and Lynda hope that they are reaching her. We met with the Probation Officer who explained the process we need to go through to place her – it includes having her interviewed by a Community Development Officer, so we’ll pursue that next.

Another birth today! The mother, in her 5^th pregnancy, was admitted at 10 a.m. and delivered a beautiful girl at 2 p.m. Nancy did the honours closely observed by the staff (and sundry others – must get dividing curtains for the ward). At one point it suddenly dawned on Nancy that there was no button on the wall to push for help, as there is at home – the responsibility was all hers and there was no fancy equipment available. Everything went well until the mother started to haemorrhage. Fortunately the team had made a special trip that morning to buy some oxytocin for just this eventuality – it worked immediately, stopping the haemorrhage. All over the developing world mothers die for lack of a 25 cent vial of oxytocin – hard to imagine but true. Many prayers of thanksgiving today.

Anna and I spent more time in Fort Portal. First we continued our year-long hunt for results of of a survey which was taken last year to track progress against the Millennium Development Goals (which cover for example, infant mortality, families’ access to water, sanitation practices, access to health services etc). The survey sampled households in the parishes around Rambia so the data would be helpful in developing projects that would improve health. We got some summaries, but were referred elsewhere for the details. Then to the Area Manager of the National Water and Sewerage Corporation who we met last year: she helped us arrange for the water at Rambia to be tested. As a leading member of Rotary in Fort Portal she also encouraged us to submit a proposal to them for a water project or for support of the clinic which we will work on next week. Next on the list was JESE (Joint Effort to Save the Environment), another local NGO who like HEWASA do water and sanitation projects, but also help communities improve agricultural practices. They too are receptive to a request from us to initiate a project.

The days are very full and we are all conscious that there is much left undone. We talk through issues at dinner, follow it up with devotions before catching up with other work, processing the day's Patient Encounter Forms and dealing with emails. All the while, looked after by the kind staff of the Lisieux Centre who try to accommodate our strange requests (could we have toilet seats please?),surprise us with unexpected dishes (pumpkin quiche, bread pudding) and start work extra early to make up lunches for us to take to the clinic (french fries - most of which found their way to hungry patients - chapatti with beef, boiled potatoes, muffins). Now if they would only deal with that pesky insomniac rooster.....

Second Day of Clinic

When the team arrived at the clinic on Tuesday morning a mother in the maternity ward had just delivered a beautiful baby girl assisted by Philip, the new Clinical Officer, and Eliza, the midwife. The mother had been at the clinic since Monday morning. Everything went well. Those donors who contributed to the delivery beds get special mention today!

Also a little girl came today who last year was about 6 months old and then was in a dire condition, not getting nearly enough milk and very much at risk; Paul and Debbie bought formula for her and made sure that she was getting it. This year she is a very chubby bouncy little girl, full of life, who might otherwise not have survived.

Today is the pre-natal clinic and there were 16 mothers, several of them waiting when the team arrived. Everyone was weighed and measured and hopefully all will keep coming back regularly.

In total 55 patients today, plus a full house in the inpatient department and the 16 expectant mothers. A full and blessed day! Lynda was run off her feet dispensing and dashing between the two buildings, still finding time to show God’s love to everyone she encounters.

Anna and I stayed in Fort Portal for meetings with churches and NGOs, following up on contacts made last year and trying to make new connections. We first met with the Church of Uganda`s Diocesan Health and Social Coordinator who advises health clinics in the Diocese and reviews their performance. Their report on Rambia was very helpful and flagged areas needing improvement. One of our challenges is that we want to fix everything but know that we can’t possibly do it in 2 weeks – even if we understood all the cultural issues which we certainly don’t. Time for the Serenity Prayer again.

Then we met with the Director of HEWASA (Health Through Water and Sanitation), an NGO administered by the Fort Portal Catholic Diocese. They deliver water and sanitation projects which address not only the required physical infrastructure but also the community participation, education and ownership aspects of such projects. The community around Rambia had a typhoid outbreak some months back so evidently there is a need for a secure and regular provision of clean water in the area. Even the water from the standpipe at the Clinic is intermittent. If we could organize a community request and funding of about $5,000 they would conduct a needs assessment and prepare a project proposal for implementation which Rambia could manage. Clean water is such a basic need, we would like to partner with Rambia to get this done if we can find the funds.

Our next stop was with a visiting Professor from the UK`s University of Warwick who has done a lot of work in the area installing micro-hydro projects and rain water collection systems. It seems that the micro-hydro project he and his students installed last year near Rambia needed repair because of erosion of the turbine by sand in the water. It is working again but Rambia would benefit from supplementing the new water supply with a rainwater collection system, something else for Anna to think about.

On our way back to Fort Portal we checked in with an orphanage to discuss how we could find a home for the abandoned girl at the clinic. Seems that the first step is to register her with the Probation Officer so we need to organize that.

After dinner Debbie led us in devotions with a theme of seeing God’s presence in even the small things and events of the day.

First Day of Clinic

Monday

Nancy, Amy and Lynda went running before breakfast much to the entertainment of the children walking to school. Us older folk were in awe of their energy. Afterwards we went to the Rambia clinic and met with the staff to review our program and priorities. We were impressed that they had already written a program which includes visits to 5 schools (in one day!), making home visits with the Village Health Workers and bringing the Village Health Workers to Rambia for training.

The number of patients grew steadily through the day but it was not too hectic – by the end of the day we had treated about 30. Amy said that she had never seen so much illness that had gone untreated for so long. Nancy is excited about an imminent delivery and Lynda handed out toothbrushes much to the excitement of the children who swarmed around her. But we are all distraught over one of the inpatients who is an emaciated 13 year old girl, with the appearance of a 5 year old. She has been abandoned and is malnourished. Some of the other patients’ families feed her at times but otherwise she is neglected. We need to find a place for her.

Towards the end of the day we were formally greeted by the Rambia Board and thanked for our work. We talked about our vision for their community to have clean water, proper sanitation, good health, improved incomes and spiritual health, and discussed the part that we hoped we and Rambia could each play in our partnership.

Shaken and Stirred

Saturday

What I expected to be a 4 hour drive from Entebbe to Fort Portal was actually just over 5 hours as a long stretch of road surface had been stripped prior to widening and repaving. No sign of the repaving however. Debbie managed heroically and is much better – must have been all the shaking and bouncing. We were welcomed warmly at the Lisieux Centre – Debbie crashed right away but the rest of us enjoyed a good dinner and soon recovered from the journey. Lisieux is a place of calm (at least it was, until we arrived) and a real sanctuary after long days.

Sunday

Lynda, Anna and I went to the English service at the Anglican Church of Uganda while the others went to mass. We had misjudged the start time so arrived half way through the service, but were still led to the front pew of a very full church. The theme of the sermon was an “Attitude of Gratitude” which I think we all had in spades, given our safe arrival. The highlight of the service was when, following the second offering, a live goat was brought up to the front, a bit too close for comfort- fortunately not to be sacrificed but to be auctioned as a fundraiser. Bidding started at about $50 (the auctioneer’s “going once, going twice” ...was accompanied by a loud gong as well as by some rather frantic bleating but no other misbehaviour) and eventually went for about $100. The successful bidder immediately donated the goat back to the church, presumably to be auctioned off again next week. If anyone is interested let us know your bid and how you’d like to take delivery.

In the afternoon we went to Rambia’s Health Centre to unpack all the meds and prepare for Monday’s patients.  For those of us who had visited Rambia before, we were thrilled to see the progress that had been made in the facility – the solar panel was powering 6 lights, water was available at a stand pipe outside, and the maternity ward and inpatient wards were finished and equipped with about 15 beds, 5 of which were occupied. We were able to fill the pharmacy shelves in the evening using the new electric light! But our new team members were overwhelmed by how basic everything is, how poor the people are, how confined the living spaces, and how ill some of the patients were. At dinner the tears flowed as we shared impressions of the day. Over dinner we talked through some of the reactions, comparing what we had seen with the situations in other countries – both good and bad. We planned the next day – Daniel wanted to us to be formally greeted by the Rambia Board and we need to decide how we will handle the flow of patients. We don’t expect many patients the first day so hopefully we will have time to get organized. We also need time for everyone to change money, do some basic shopping, and get phones and internet access organized.

Safe Arrival

We all arrived on time last night at Entebbe with all our luggage and boxes of meds and supplies – I always have a sense of wonder when a plan comes together. Paul and Debbie cut things a little fine in arriving at Toronto airport and although KLM had refused to give us extra luggage allowance we actually didn’t need it and managed to get everything checked in. Flights were on time and uneventful. What a thrill to see Daniel at the airport waiting for us – complete with two vans, one already loaded down with the meds he had picked up earlier from the Joint Medical Store in Kampala. Lynda’s flight arrived from Brussels shortly after ours and we met her off the plane. During the short ride from the airport we managed a quick burst of “Happy Birthday” to Anna (team singing needs work) and then, with Daniel, checked into the Entebbe Travellers Inn where, another wonder, they were actually expecting us. We are on the northern tip of Lake Victoria and we can see the lake from the hotel.

We were keen to get news of the clinic and Daniel told us that the solar panel is in, two mothers have already given birth at the new maternity ward and there are many patients at the in-patient department. Water is now available from a stand-pipe but is not piped into the buildings. Nancy is hoping that there will be more mothers to deliver while we are there, but no promises from Daniel!

The bad news is that Debbie had a rough night and is not well enough to travel. Something has triggered an allergic reaction. So rather than drive to Fort Portal right away we are going to stay at the hotel for a while and see if she recovers. There is no lack of meds to help her along. While we are waiting a storm has rolled in from the north heading over Lake Victoria bringing torrential rain for a brief spell.

We can feel the love!

We leave for Uganda tomorrow evening and as usual, it's rather hectic getting ready to leave. Paul and Debbie have been ordering medications and supplies for us to collect in Uganda when we arrive, as well as from Health Partners International Canada which provides drugs donated by Canadian pharmaceutical companies. We have all been gathering gifts like soccer and volley balls, and receiving donated supplies and I suspect we won't know until we check in, just how much we'll be able to take on the plane without having to pay excess baggage.  I've asked KLM for extra luggage allowance for the team, but no reply yet. And we hope Daniel is able to meet us in Entebbe with a vehicle that will have enough room for all of us and our luggage.

But amidst all the busy-ness we are very appreciative of all the support we have received, whether prayer, financial or in-kind support. Many donors have made this trip possible and we'd like to thank in particular the members of Bayview Glen Church and friends who so generously opened their hearts and wallets to raise $3,000 to fund lighting for the Rambia clinic. Anna and I were formally commissioned by Yorkminster Park Baptist Church at the morning service on September 5 and the prayer support of our Church was very moving for us - it was particulary poignant because we followed the morning "time with the children" which reminded meof the high infant mortality rate that prevails in Uganda.  I'll try to mention other donors and support we have received in subsequent postings. But for now, thank you all for your support and encouragement, it means a lot to us!

RAMBIA - Our Partner in Uganda

Two years ago I responded to a request for an EMAS medical team received from RAMBIA, a small NGO near Fort Portal in the far west of Uganda. I was already scheduled to be in Kenya so it was relatively easy to add a trip to see Rambia. I was met in Kampala by Rambia's Executive Director, Daniel Bwambale and after a 4 - hour bus ride to Fort Portal I found myself on the back of Daniel's motor bike slip-sliding up a muddy trail to meet his Board. I learned that the community had pooled their resources from various activities such as bee-keeping and brick making and used the funds to build a small health centre. The centre consisted of two buildings: one housing a dispensary, laboratory and consultation rooms; and the other, under construction, but planned to accommodate a maternity ward and in-patient department. In spite of few resources, difficult circumstances (the mud road, no water, no electricity, no money for regular salaries) they were determined to improve the conditions of their community. And they had taken the initiative to find us and ask for a medical team to come.

 The clinic has a staff of 6:

• Bisunga Wesely, Clinical Officer in charge;
• Biira Maureen, Comprehensive Nurse;
• Baloko Johnson, Nursing Assistant;
• Muhindo Besa, Nursing Assistant;
• Kemigisha Florence, Enrolled midwife; and
• Mudama Fred, Laboratory technician.

 The addition of the maternity ward is a major initiative by Rambia to try and address the problem of high maternal and infant mortality. Women living on the hillsides rely on Traditional Birth attendants to deliver their babies and in the event of complications can't get to a hospital or have access to the most basic of meds and treatment. So one of our objectives this trip is to support in any way we can Rambia's drive to help mothers and babies. A number of EMAS donors have contributed funds to complete the Maternity Ward and we are looking forward to seeing the progress made.

The exact location if you'd like to try and find them on Google is Kyamukube Trading Centre, Nsurra Parish, Katebwa Sub-County.  Rambia is an amazing organization with a mission to improve the lives of the rural population and Daniel, the volunteer Executive Director, and his Board are resourceful and passionate about what they do. We are very fortunate to be working alongside them.

Introducing the EMAS Uganda Team

We have an expanded team going to Uganda this year to work with Rambia (I'll tell you more about Rambia in a subsequent post) and I'd like to introduce them to you:

• Drs Paul and Debbie Zeni of Georgetown, Ontario are our Team Leaders. Debbie is a Family Physician specalizing in obstetrics and paediatrics, while Paul is Co-Chief of Surgery at Georgetown Hospital. Paul and Debbie made the first visit to Rambia last year and its thanks to their passion and enthusiasm that we have a larger team this year;
• Dr Amy Bourns (PGY-2) is a Family Medicine Resident at the University of Toronto - this will be Amy's first visit to Rambia;
• Nancy Sullivan is a Perinatal-Obstetrical Nurse at the Ottawa Hospital and attends the Eglise Sainte-Marie in Orleans-Ottawa - this will be Nancy's first visit to Rambia;
• Lynda (Broughton) Audia is a Public Health Nurse, Chronic Disease Prevention and Health Promotion with the City of Toronto. She is a member of Bayview Glen Christian Missionary Alliance Church in  Markham. The staff and community at Rambia will be thrilled to see Lynda again as she made so many friends during her visit last year;
• Anna Dunets Wills is a water and sanitation engineer with rePlan in Toronto, and a member of Dewi Sant Welsh United Church; and
• Yours truly, Executive Director of EMAS and a member of Yorkminster Park Baptist Church in Toronto.

Debbie, Paul, Amy, Nancy and Lynda will be seeing and treating patients, teaching the Rambia staff, working with Village Health Teams and visiting schools. Anna will be looking into the physical infrastructure at the health clinic - buildings, water, electricty and sanitation. I will be working on institutional issues affecting Rambia and the health clinic and investigating opportunities for us to work with women's groups and microfinance projects in the community.

We are blessed to have such a talented and enthusiastic team and pray that we will be able to be useful to the community we will be visiting.